Good Catch Form

Good Catch Form
Project Location*
Company Name:*
Date*

MonthDayYear
Date
Time*

Hour Minutes

AM/PM Option
Incident Type*

Good Catch = Unsafe conditions, opportunities for improvementNear Miss = An unplanned event which did not result in injury, illness or damage but had the potential to do so
What type of Hazard?*

Arc FlashBatteriesConfined SpaceElectricalEnvironmentalExcavation and TrenchesFall ProtectionFire/ Hot WorkHand/ Power ToolsHazComHeavy EquipmentHousekeepingLaddersLOTOMaterial HandlingMotor VehiclesOperating EquipmentPersonal Protective Equipment PPEWalking/ Working SurfacesOther
Description of Event:*
Immediate Action Taken:*
Suggestions to Prevent Similar Occurrence/ Corrective Actions:*
Reporters Name (your name)

First NameLast Name
Should be Empty: